ABSTRACT
Objectives: Healthcare systems require comprehensive data for long-term resource allocation planning to support people living with post-COVID-19 condition (PCC). Limited information is available on long-term PCC-associated healthcare utilization patterns. In this study, we assess healthcare utilization rates six and 12-18 months following acute COVID-19 illness among COVID-19 survivors in British Columbia (BC), Canada by PCC status. Method(s): We used difference-in-difference analysis to assess healthcare utilization by all adult COVID-19 survivors in BC diagnosed with COVID-19 on/before November 18, 2021 during three time periods: (i) 26 weeks after the first 4 weeks of COVID-19 illness, and that exact period (ii) one or two years prior (baseline), and (iii) one year afterwards. PCC/non-PCC patients were matched 1:2 on age, sex, region, comorbidities, vaccination status, and COVID-19 index date +/-14 days. The total number of daily healthcare encounters (medical visit, emergency department visit, hospitalization) per person was calculated. Rate ratios (RR) for PCC-associated healthcare utilization were estimated using weighted Poisson regression. Result(s): The matched cohort (n= 7,092) included 2,364 PCC patients (54.9% female;mean age 39.8 [SD, 13.4] years). Healthcare utilization rates were comparable between the PCC and non-PCC groups at baseline (average: 39.3 vs. 32.7 visits per 1000 patients, respectively), but rose two-fold for the PCC group during the 26-week period post-acute illness (76.1 vs. 33.5). One year later, PCC-associated healthcare utilization rates declined but remained elevated relative to baseline rates (54.6 vs. 34.4). In multivariable Poisson regression models, PCC was associated with a 103% increase in healthcare utilization over 26 weeks post-acute illness (aRR: 2.03, 95% CI 1.71-2.41) and a 24% increase the next year (aRR: 1.24, 95% CI 1.03-1.48). Conclusion(s): The increased healthcare utilization rates noted among PCC patients one year following acute COVID-19 illness highlights the need for adequate planning to provide optimal support for people living with PCC.Copyright © 2023
ABSTRACT
Intro: SARS-CoV-2 infection primarily affects the respiratory system. However, other organ systems may also be involved, leading to acute and chronic sequelae. Among other post-acute sequelae, incident diabetes is also being assessed but population-based evidence is still sparse. We evaluated the association between COVID-19 infection including severity of infection and diabetes incidence using population-based registries and datasets. Method(s): We conducted a population-based matched retrospective cohort study using data from the BC COVID-19 Cohort. The exposure was SARS-CoV-2 infection, and the primary outcome was incident diabetes identified >30 days after the specimen collection-date for COVID-19 test. We performed multivariable Cox proportional hazard modeling to assess the effect of COVID-19 infection and disease severity on diabetes. Stratified analyses were performed to evaluate the effect modification of SARS-CoV-2 infection on diabetes risk. Finally, we computed, the confounder-adjusted population attributable fraction from the Cox models Findings: During the median follow-up of 257 days, 608 (0.5%) events were observed among exposed and 1,864 (0.4%) among unexposed. Incident-diabetes rate/100,000 person-years was significantly higher among the exposed group vs. unexposed group (672.2 vs 508.7 respectively). The risk of incident diabetes was higher among those with COVID-19 infection (HR=1.16, 95% CI:1.06-1.28), and among males (aHR=1.22, 95%CI:1.06-1.40). The risk of diabetes was much higher among people with more severe disease (HRICU=3.32, 95%CI:1.99 - 5.54;HRhospitalized=1.97, 95%CI:1.33 - 2.93). Conclusion(s): SARS-CoV-2 infection is associated with higher risk of diabetes overall and among males. Severe SARS-CoV-2 infection is associated with higher risk of diabetes among both males and females. Furthermore, infection with SARS-CoV-2 could contribute to 3-5% increase in burden of diabetes, which will result in substantial number of diabetes cases with impact on healthcare needs for management of diabetes and its complications in addition to health of affected population.Copyright © 2023
ABSTRACT
Background: Many services including those related to hepatitis C virus (HCV) care were disrupted during the COVID-19 pandemic. We assessed the impact of the COVID-19 pandemic on the HCV care cascade in Rwanda. Methods: This study used data from the Rwanda Health Management Information System. We included data for all individuals who received HCV services from screening to treatment and cure [sustained virological response at week 12 (SVR12)], from July 2019 to June 2020. We defined HCV care cascade as: 1) HCV antibody (Ab) positive, 2) HCV RNA tested, 3) HCV RNA detectable, 4) patients eligible for treatment, 5) patients on treatment, 6) assessed for SVR12, 7) achieved SVR12. Results: Between July 2019 and June 2020, 1,909,450 persons were screened for HCV in Rwanda (95,899 screened from July to December 2019, and 1,813,551 from January to June 2020). From January 2020, HCV elimination plan was implemented, with an increased allocation of resources for HCV-related services. Overall, 60,961 people (3.19%) were screened positive for HCV-Ab, the highest prevalence in November 2019 (11.9%), and the lowest in June 2020 (1.47%). Among those who were HCVAb positive, 31.33% (47.54% in 2019 vs 29.1% in 2020) were tested for HCV RNA, and 77.63% of those had a detectable viral load (77.63% in both 2019 and 2020). Of 25,056 people eligible for HCV treatment (people over 17 years old, nonpregnant or breastfeeding women, patients without HCC), 69.76% started treatment (95.14% in 2019 vs 52.15% in 2020). Among 6,714 who completed HCV treatment, 50.59% (22.34% in 2019 vs 74.49% in 2020) were assessed for SVR12. From July 2019 to June 2020, the number of people screened for HCV-Ab increased, while the proportion of patients tested for HCV RNA among those who were HCVAb positive decreased from October 2019. Conclusion: The number of people screened and treated for HCV increased in Rwanda during the study period. Overall, more people were screened during the period of early 2020 compared to the later part of 2019, suggesting that the COVID-19 pandemic did not disrupt screening. However, the proportion of patients who received subsequent services in the HCV care cascade are still low and decreased in 2020 compared to 2019, which is likely due to the impact of the COVID-19 pandemic. There is a need to plan the re-engagement of individuals who may have experienced delays in hepatitis care during the COVID-19 pandemic in order to achieve the hepatitis elimination goals. .
ABSTRACT
Background: Increased hepatitis C virus (HCV) testing among people in prison (PIP) is key for HCV elimination efforts to be successful. Efforts to improve health care in all British Columbia (BC) Provincial Correctional Centres (PCCs) have been made in recent years, beginning with the transfer of health services from BC Corrections to BC Provincial Health Services Authority (PHSA) in 2017. However, the state of emergency declared in BC in early 2020 in response to the COVID-19 pandemic may have undermined these efforts. This study aims to examine patterns in HCV screening and diagnosis in all 10 BC PCCs before and during the COVID-19 pandemic. Methods: Data from the BC Sexually Transmitted and Blood-Borne Infections Data Mart, which contains laboratory data accounting for >95% of all anti-HCV and >99% of all HCV RNA and genotype tests performed in BC, were used for this study. The number of anti-HCV, HCV RNA and HCV genotype tests that were ordered from BC PCCs between April 1 2011 and March 31 2021 was determined for quarterly periods. New HCV diagnoses were defined as the number of 1st-time HCV-positive test episodes (anti-HCV, RNA or genotype) among HCV tests ordered from BC PCCs. Total intake numbers were provided by BC Corrections per calendar year. Results: The number of HCV antibody, RNA, and genotype tests ordered from BC PCCs in the 1st quarter of 2020 had increased by 412% (n=486), 530% (n=252) and 827% (n=139) respectively (Figure 1), compared to the 1st quarter of 2017 (prior to the transfer of health services to PHSA). Following the beginning of the COVID-19 pandemic, the number of HCV antibody, RNA, and genotype tests ordered from BC PCCs in the 2nd quarter of 2020 had decreased by 66% (n=165), 67% (n=83) and 68% (n=44), respectively (Figure 1), compared to the 1st quarter of 2020. The total number of HCV tests as a proportion of intakes to BC PCCs in 2019 was 17% (2518/15303), which increased to 23% (2112/9283) in 2020. Conclusion: The transfer of health services in BC PCCs to PHSA led to increased volume of HCV screening, with concomitant increases in new HCV diagnoses among PIP in BC from 4th quarter 2017 onwards. The COVID-19 pandemic led to health care challenges in prisons in BC (including the suspension of non-urgent HCV testing in the entire province for several weeks), and at the same time, the number of HCV tests and new diagnoses decreased. This may have been partly due to reduced intakes to BC PCCs over 2020, as the total number of HCV tests ordered as a proportion of intakes increased in 2020, compared to the previous year. Those people diverted away from the correctional system due to decarceration efforts triggered by COVID-19 may have missed out on HCV screening during 2020, therefore further efforts to increase HCV screening in correctional settings and the community will be needed.